Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema

Effect on intracranial pressure and lateral displacement of the brain

Adnan I. Qureshi, Jose I. Suarez, Anish Bhardwaj, Marek Mirski, Mark S. Schnitzer, Daniel F. Hanley, John A. Ulatowski

Research output: Contribution to journalArticle

189 Citations (Scopus)

Abstract

Objective: To determine the effect of continuous hypertonic (3%) saline/acetate infusion on intracranial pressure (ICP) and lateral displacement of the brain in patients with cerebral edema. Design: Retrospective chart review. Settings: Neurocritical care unit of a university hospital. Patients: Twenty-seven consecutive patients with cerebral edema (30 episodes), including patients with head trauma (n = 8), postoperative edema (n = 5), nontraumatic intracranial hemorrhage (n = 8), and cerebral infarction (n = 6). Intervention: Intravenous infusion of 3% saline/acetate to increase serum sodium concentrations to 145 to 155 mmol/L. Measurements and Main Results: A reduction in mean ICP within the first 12 hrs correlating with an increase in the serum sodium concentration was observed in patients with head trauma (r2 = .91, p = .03), and postoperative edema (r2 = .82, p = .06), but not in patients with nontraumatic intracranial hemorrhage or cerebral infarction. In patients with heed trauma, the beneficial effect of hypertonic saline on ICP was short-lasting, and after 72 hrs of infusion, four patients required intravenous pentobarbital due to poor ICP control. Among the 21 patients who had a repeat computed tomographic scan within 72 hrs of initiating hypertonic saline, lateral displacement of the brain was reduced in patients with head trauma (2.8 ± 1.4 to 1.1 ± 0.9 [SEM]) and in patients with postoperative edema (3.1 ± 1.6 to 1.1 ± 0.7). This effect was not observed in patients with nontraumatic intracranial bleeding or cerebral infarction. The treatment was terminated in three patients due to the development of pulmonary edema, and was terminated in another three patients due to development of diabetes insipidus. Conclusions: Hypertonic saline administration as a 3% infusion appears to be a promising therapy for cerebral edema in patients with head trauma or postoperative edema. Further studies are required to determine the optimal duration of benefit and the specific patient population that is most likely to benefit from this treatment.

Original languageEnglish (US)
Pages (from-to)440-446
Number of pages7
JournalCritical Care Medicine
Volume26
Issue number3
DOIs
StatePublished - 1998
Externally publishedYes

Fingerprint

Brain Edema
Intracranial Pressure
Acetates
Brain
Therapeutics
Craniocerebral Trauma
Edema
Cerebral Infarction
Intracranial Hemorrhages
Sodium
Diabetes Insipidus
Pulmonary Edema
Pentobarbital
Serum
Intravenous Infusions

Keywords

  • Cerebral edema
  • Cerebral infarction
  • Computed tomography
  • Glasgow Coma Scale
  • Glasgow Outcome Scale
  • Head trauma
  • Hypertonic saline
  • Intracerebral hemorrhage
  • Intracranial pressure
  • Osmolality
  • Sodium

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema : Effect on intracranial pressure and lateral displacement of the brain. / Qureshi, Adnan I.; Suarez, Jose I.; Bhardwaj, Anish; Mirski, Marek; Schnitzer, Mark S.; Hanley, Daniel F.; Ulatowski, John A.

In: Critical Care Medicine, Vol. 26, No. 3, 1998, p. 440-446.

Research output: Contribution to journalArticle

Qureshi, Adnan I. ; Suarez, Jose I. ; Bhardwaj, Anish ; Mirski, Marek ; Schnitzer, Mark S. ; Hanley, Daniel F. ; Ulatowski, John A. / Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema : Effect on intracranial pressure and lateral displacement of the brain. In: Critical Care Medicine. 1998 ; Vol. 26, No. 3. pp. 440-446.
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abstract = "Objective: To determine the effect of continuous hypertonic (3{\%}) saline/acetate infusion on intracranial pressure (ICP) and lateral displacement of the brain in patients with cerebral edema. Design: Retrospective chart review. Settings: Neurocritical care unit of a university hospital. Patients: Twenty-seven consecutive patients with cerebral edema (30 episodes), including patients with head trauma (n = 8), postoperative edema (n = 5), nontraumatic intracranial hemorrhage (n = 8), and cerebral infarction (n = 6). Intervention: Intravenous infusion of 3{\%} saline/acetate to increase serum sodium concentrations to 145 to 155 mmol/L. Measurements and Main Results: A reduction in mean ICP within the first 12 hrs correlating with an increase in the serum sodium concentration was observed in patients with head trauma (r2 = .91, p = .03), and postoperative edema (r2 = .82, p = .06), but not in patients with nontraumatic intracranial hemorrhage or cerebral infarction. In patients with heed trauma, the beneficial effect of hypertonic saline on ICP was short-lasting, and after 72 hrs of infusion, four patients required intravenous pentobarbital due to poor ICP control. Among the 21 patients who had a repeat computed tomographic scan within 72 hrs of initiating hypertonic saline, lateral displacement of the brain was reduced in patients with head trauma (2.8 ± 1.4 to 1.1 ± 0.9 [SEM]) and in patients with postoperative edema (3.1 ± 1.6 to 1.1 ± 0.7). This effect was not observed in patients with nontraumatic intracranial bleeding or cerebral infarction. The treatment was terminated in three patients due to the development of pulmonary edema, and was terminated in another three patients due to development of diabetes insipidus. Conclusions: Hypertonic saline administration as a 3{\%} infusion appears to be a promising therapy for cerebral edema in patients with head trauma or postoperative edema. Further studies are required to determine the optimal duration of benefit and the specific patient population that is most likely to benefit from this treatment.",
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AU - Suarez, Jose I.

AU - Bhardwaj, Anish

AU - Mirski, Marek

AU - Schnitzer, Mark S.

AU - Hanley, Daniel F.

AU - Ulatowski, John A.

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N2 - Objective: To determine the effect of continuous hypertonic (3%) saline/acetate infusion on intracranial pressure (ICP) and lateral displacement of the brain in patients with cerebral edema. Design: Retrospective chart review. Settings: Neurocritical care unit of a university hospital. Patients: Twenty-seven consecutive patients with cerebral edema (30 episodes), including patients with head trauma (n = 8), postoperative edema (n = 5), nontraumatic intracranial hemorrhage (n = 8), and cerebral infarction (n = 6). Intervention: Intravenous infusion of 3% saline/acetate to increase serum sodium concentrations to 145 to 155 mmol/L. Measurements and Main Results: A reduction in mean ICP within the first 12 hrs correlating with an increase in the serum sodium concentration was observed in patients with head trauma (r2 = .91, p = .03), and postoperative edema (r2 = .82, p = .06), but not in patients with nontraumatic intracranial hemorrhage or cerebral infarction. In patients with heed trauma, the beneficial effect of hypertonic saline on ICP was short-lasting, and after 72 hrs of infusion, four patients required intravenous pentobarbital due to poor ICP control. Among the 21 patients who had a repeat computed tomographic scan within 72 hrs of initiating hypertonic saline, lateral displacement of the brain was reduced in patients with head trauma (2.8 ± 1.4 to 1.1 ± 0.9 [SEM]) and in patients with postoperative edema (3.1 ± 1.6 to 1.1 ± 0.7). This effect was not observed in patients with nontraumatic intracranial bleeding or cerebral infarction. The treatment was terminated in three patients due to the development of pulmonary edema, and was terminated in another three patients due to development of diabetes insipidus. Conclusions: Hypertonic saline administration as a 3% infusion appears to be a promising therapy for cerebral edema in patients with head trauma or postoperative edema. Further studies are required to determine the optimal duration of benefit and the specific patient population that is most likely to benefit from this treatment.

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KW - Intracerebral hemorrhage

KW - Intracranial pressure

KW - Osmolality

KW - Sodium

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